Does 95938 require prior authorization?

No, 95938 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 95938?

Medicare facility rate: $400.14. Non-facility rate: $400.14. Work RVU: 0.84.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.84

Facility

$400.14

Non-Facility

$400.14

Refer to LCD L34975 for the detailed reasonable and necessary clinical criteria and documentation required to support coverage of NEPs.
Use CPT codes 95925, 95926, 95927, 95928, 95929, 95938, and 95939 for Somatosensory Evoked Potentials/Responses (SEPs/SERs).
Use CPT codes 92651, 92652, and 92653 for Brainstem Auditory Evoked Potentials/Responses (BAEPs/BAERs).
Use CPT code 95930 for Visual Evoked Potentials/Responses (VEPs/VERs).

Neurophysiology Evoked Potentials (NEPs) — including Somatosensory Evoked Potentials (SEPs), Brainstem Auditory Evoked Potentials (BAEPs/BAERs), and Visual Evoked Potentials (VEPs/VERs) — are covered when determined to be reasonable and necessary in accordance with LCD L34975.
Somatosensory testing is covered when it is medically necessary, ordered by a referring/ordering physician, and the medical record documents relevant history, physical exam, and pertinent diagnostic tests supporting the need for the test.
Diagnostic somatosensory tests should be performed when test results are expected to influence or contribute to the patient’s course of treatment.
For diagnostic tests, report the test result if known; if result is not available, report the symptoms that prompted the test on the claim.
Somatosensory evoked potential (SEP) testing should be billed using CPT codes 95925, 95926, 95927, or 95938 when an SEP study (not QST) is performed.
Intraoperative somatosensory monitoring during spinal surgeries may be billed with CPT 95940 or HCPCS G0453 in conjunction with the SEP study (95925, 95926, 95927, or 95938) when continuous one-on-one monitoring is provided.

L34624 — Somatosensory Testing

J05

A57597 — Billing and Coding: Somatosensory Testing

J05

L33693 — Peripheral Venous Ultrasound

J09

L35007 — Vestibular and Audiologic Function Studies

J12

L35434 — Oximetry Services

Ask Verity about documentation requirements, denial risks, or coverage in your state.